Tai Tonga 41 OCC Membership Form

Tai Tonga 41 Outrigger Canoe Club Inc
C/- 97 View Road
Melrose
WELLINGTON

APPLICATION FOR MEMBERSHIP

Name: Male / Female

(cross out one)

Date of Birth:

Address:

Contact phone numbers:

E-mail address:

I am eligible to paddle in the following categories (Please circle)

Juniors Open Masters Senior Masters

Team Name (if known):

Please supply copy of birth certificate/passport to be held as verification of

age. (Nga Kaihoe requirement that clubs are able to verify ages if required to.

do so.)

I will / will not be paddling wearing a life jacket

I agree to abide by the rules of Tai Tonga 41 Outrigger Canoe Club Inc.

Signed: Date:

Membership $   75.00 Single

$ 145.00 Whanau (living under the same roof)

$   20.00 Intermediate / Junior

$   50.00 Unwaged

Name:				Male / Female
				(cross out one)
Date of Birth:

Address:

Contact phone numbers:

E-mail address:

I am eligible to paddle in the following categories (Please circle)

Juniors	Open	Masters		Senior Masters

Team Name (if known):

Please supply copy of birth certificate/passport to be held as verification of
age. (Nga Kaihoe requirement that clubs are able to verify ages if required to.
do so.)

I will / will not be paddling wearing a life jacket

I agree to abide by the rules of Tai Tonga 41 Outrigger Canoe Club Inc.


Signed:			Date:


Membership	$ 75.00	Single
	$ 145.00	Whanau (living under the same roof)
	$ 20.00	Intermediate / Junior
	$ 50.00	Unwaged